Hirose Wataru, Harigai Masayoshi, Amano Koichi, Hidaka Toshihiko, Itoh Kenji, Aoki Kazutoshi, Nakashima Masahiro, Nagasawa Hayato, Komano Yukiko, Nanki Toshihiro
Hirose Clinic of Rheumatology, Saitama, Japan.
Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
Rheumatol Adv Pract. 2022 Oct 29;6(3):rkac090. doi: 10.1093/rap/rkac090. eCollection 2022.
We compared the 52-week effectiveness and safety of tofacitinib (TOF) and abatacept (ABT) in patients with RA in a real-world setting and investigated a role of human leucocyte antigens (HLA)-DRB1 shared epitope (SE) in the effectiveness.
RA patients starting TOF ( = 187) and ABT ( = 183) were enrolled. Effectiveness was compared after reducing the selection bias to a minimum using the inverse probability of treatment weighting (IPTW) based on propensity scores. The influence of SE alleles on effectiveness was compared within each treatment group. A treatment group comparison was also performed within SE-positive and SE-negative groups.
Herpes zoster and some laboratory abnormalities were more frequent in the TOF group than in the ABT group. Patient characteristics did not differ significantly between treatment groups after adjustments with IPTW. The TOF group had a significantly higher proportion of DAS in 28 joints using ESR (DAS28-ESR) remission at week 52 than the ABT group. The DAS28-ESR at week 12 and thereafter was not affected by the copy number of SE alleles in the TOF group, but decreased significantly as the copy number increased in the ABT group. In SE-positive patients, remission and drug retention rates did not differ significantly between the two treatment groups. In SE-negative patients, the TOF group showed significantly higher remission and drug retention rates than the ABT group.
The present results suggest that TOF is more effective with regard to remission at week 52 based on treatment responses in SE-negative RA patients.
我们在真实世界环境中比较了托法替布（TOF）和阿巴西普（ABT）对类风湿关节炎（RA）患者的52周有效性和安全性，并研究了人类白细胞抗原（HLA）-DRB1共享表位（SE）在有效性中的作用。
纳入开始使用TOF（n = 187）和ABT（n = 183）的RA患者。使用基于倾向评分的治疗权重逆概率（IPTW）将选择偏倚降至最低后比较有效性。在每个治疗组中比较SE等位基因对有效性的影响。还在SE阳性和SE阴性组内进行了治疗组比较。
TOF组带状疱疹和一些实验室异常情况比ABT组更常见。经IPTW调整后，治疗组之间的患者特征无显著差异。TOF组在第52周时使用红细胞沉降率（ESR）的28个关节疾病活动度评分（DAS28-ESR）缓解的比例显著高于ABT组。在TOF组中，第12周及之后的DAS28-ESR不受SE等位基因拷贝数的影响，但在ABT组中随着拷贝数增加而显著降低。在SE阳性患者中，两个治疗组之间的缓解率和药物保留率无显著差异。在SE阴性患者中，TOF组的缓解率和药物保留率显著高于ABT组。
目前的结果表明，基于SE阴性RA患者的治疗反应，TOF在第52周缓解方面更有效。
Zotero 插件
